Pennsylvania Medicaid Dental Coverage Guide
Pennsylvania Medicaid Dental Coverage Guide: verify the Pennsylvania authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
Pennsylvania Medicaid Dental Coverage Guide: verify the Pennsylvania authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check. Pennsylvania Medicaid pays a dentist $36.00. Pennsylvania Medicaid pays a dentist $500.00.
What this page recommends
Pennsylvania Medicaid Dental Coverage Guide: verify the Pennsylvania authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
- Next step: Find a Provider
What should I verify before acting?
Verify the local workflow, provider fit, pricing details, and timing directly through the canonical guide or a qualified professional before making a decision.
Related decision paths people also use
These are nearby ways people describe the same decision before they move into local comparison, pricing, or urgent next-step mode.
Pennsylvania Medicaid dental reimbursement rates on this page are taken from Medical Assistance Program Dental Fee Schedule, published by Pennsylvania Department of Human Services, and retrieved 2026-08-26. The schedule is effective 2026-08-01. Every amount shown is what the state pays a dental provider for the procedure. It is not a price a patient pays, and self-pay and insured prices are typically far higher. Pennsylvania operates a limited adult dental benefit for adults 21 and over; children's dental care is required federally under EPSDT. Verified 2026-08-26.
Pennsylvania Medicaid dental reimbursement: what the program pays a dentist, not what a patient pays
| Procedure (CDT code) | What Pennsylvania Medicaid pays the dentist | Rate basis |
|---|---|---|
| Cleaning (prophylaxis), adult (CDT D1110) | Pennsylvania Medicaid pays a dentist $36.00 | State reimbursement, effective 2026-08-01 |
| Crown, porcelain/ceramic (CDT D2740) | Pennsylvania Medicaid pays a dentist $500.00 | State reimbursement, effective 2026-08-01 |
| Root canal, molar tooth (CDT D3330) | Pennsylvania Medicaid pays a dentist $500.00 | State reimbursement, effective 2026-08-01 |
| Extraction, erupted tooth (simple) (CDT D7140) | Pennsylvania Medicaid pays a dentist $65.00 | State reimbursement, effective 2026-08-01 |
| Cleaning (prophylaxis), child (CDT D1120) | Pennsylvania Medicaid pays a dentist $30.00 | State reimbursement, effective 2026-08-01 |
| Fluoride varnish (paediatric preventive) (CDT D1206) | Pennsylvania Medicaid pays a dentist $18.00 | State reimbursement, effective 2026-08-01 |
| Sealant, per tooth (paediatric preventive) (CDT D1351) | Pennsylvania Medicaid pays a dentist $25.00 | State reimbursement, effective 2026-08-01 |
| Root canal, anterior tooth (CDT D3310) | Pennsylvania Medicaid pays a dentist $275.00 | State reimbursement, effective 2026-08-01 |
| Root canal, premolar tooth (CDT D3320) | Pennsylvania Medicaid pays a dentist $375.00 | State reimbursement, effective 2026-08-01 |
| Surgical extraction, erupted tooth (CDT D7210) | Pennsylvania Medicaid pays a dentist $65.00 | State reimbursement, effective 2026-08-01 |
Ready to compare providers?
Use the source-backed framework above, then continue to the matching provider destination.
Verify the rule before acting
- State Medicaid and CHIP Profiles — State-specific Medicaid and CHIP program profile; reviewed 2026-08-26
- Dental Care — Federal dental benefit requirements and state-option context; reviewed 2026-08-26
- Dental Licensure by State — State dental board and licensure pathway discovery; reviewed 2026-08-26
- Medical Assistance Program Dental Fee Schedule — Official Pennsylvania Medicaid dental fee schedule: amounts the state pays a dental provider per CDT procedure. Not consumer prices.; reviewed 2026-08-26
- Pennsylvania Medicaid adult dental benefit scope — Pennsylvania's own statement of what dental care adult Medicaid members receive; reviewed 2026-08-26
Pennsylvania publishes its Medicaid dental reimbursement rates in Medical Assistance Program Dental Fee Schedule. Those rates are what Pennsylvania Medicaid pays a dental provider for each procedure, and they are not prices a patient pays. A self-pay or insured price for the same procedure is normally much higher, so a Pennsylvania reimbursement figure cannot answer what a filling or a crown would cost you. It does answer what Pennsylvania Medicaid will pay a dentist who accepts it. The figures on this page were retrieved 2026-08-26.
Quick checklist
- Record the event date and the decision deadline for the Pennsylvania issue.
- Select Pennsylvania in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Capture the operative rule, not merely a search-result snippet.
- Use Find a Provider if interpretation or application remains uncertain.
Red flags
- A stale screenshot used as the only evidence
- No distinction between federal and Pennsylvania requirements
- A recommendation based only on advertising position
Adult and child dental benefits are set differently in Pennsylvania. Children's dental coverage is federally required under EPSDT, so every state must cover medically necessary dental care for eligible children. Adult dental coverage is a state option, which is why it varies so sharply. Pennsylvania operates a limited adult dental benefit for adults aged 21 and over. In the state's own words: "These services include diagnostic (exam & x-rays), preventive (prophys), restorations (amalgam and composite restorations), extractions, and other types of oral surgery. Diagnostic and preventive services are limited to 1 per 180 days per adult recipient. Root canals (endodontic services), crowns and adjunctive services, and periodontal services require an approved benefit limit exception in order for the service to " Confirm your own category before booking, because Pennsylvania eligibility groups can differ. Verified 2026-08-26.
Quick checklist
- Name the exact Pennsylvania decision and the date that could change it.
- Select Pennsylvania in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Save the source URL, page title, and review date in your notes.
- Compare provider scope and written terms before using Find a Provider.
Red flags
- A stale screenshot used as the only evidence
- No distinction between federal and Pennsylvania requirements
- A recommendation based only on advertising position
For “What should I confirm before booking Medicaid dental care in Pennsylvania?,” Before relying on a Pennsylvania summary, confirm the issue through Medicaid.gov’s Pennsylvania profile and the current Pennsylvania Medicaid dental program materials. Record the source date and verify child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. After the source check, Find a Provider routes you to the relevant local directory or service path.
Quick checklist
- Record the event date and the decision deadline for the Pennsylvania issue.
- Select Pennsylvania in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Capture the operative rule, not merely a search-result snippet.
- Use Find a Provider if interpretation or application remains uncertain.
Red flags
- A stale screenshot used as the only evidence
- No distinction between federal and Pennsylvania requirements
- A recommendation based only on advertising position
For “How do prior authorization and managed-care rules affect Pennsylvania dental access?,” The defensible starting point in Pennsylvania is Medicaid.gov’s Pennsylvania profile and the current Pennsylvania Medicaid dental program materials, not an undated national summary. Then confirm child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. Do not rely on the summary alone; verify first, then use Find a Provider.
Quick checklist
- Write the Pennsylvania question in one sentence.
- Select Pennsylvania in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Check the exception, eligibility category, or license status that applies.
- Route to the canonical provider destination with the verified facts in hand.
Red flags
- A generic fifty-state chart replacing Pennsylvania primary material
- No license or designation verification
- Pressure to act before written terms are supplied
For “When should I use Find a Provider for Medicaid dental care in Pennsylvania?,” The controlling verification path for Pennsylvania runs through Medicaid.gov’s Pennsylvania profile and the current Pennsylvania Medicaid dental program materials; screenshots and blog charts are secondary. Use the source to separate general guidance from child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. Use Find a Provider only after the authority check so the next conversation starts with the right questions.
Quick checklist
- Identify the person, service, and jurisdiction involved in Pennsylvania.
- Select Pennsylvania in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from Pennsylvania-specific rules.
- Ask the provider to explain any conflict in writing.
Red flags
- An authority link that does not identify Pennsylvania or the topic
- A summary that hides exceptions
- A provider answer that changes when you ask for documentation
Need help applying this guide?
- Oregon Medicaid Dental Coverage Guide
- Rhode Island Medicaid Dental Coverage Guide
- Neuropsychological Evaluation Access in Pennsylvania
- Pennsylvania Comparative or Contributory Negligence Rules
- Pennsylvania Dental Insurance Marketplace Guide
- Pennsylvania Personal Injury Statute of Limitations
- Telehealth TRT Rules in Pennsylvania
- TRT Legality and Prescribing Rules in Pennsylvania
- USCIS Civil Surgeons in Pennsylvania